Healthcare Provider Details

I. General information

NPI: 1467175919
Provider Name (Legal Business Name): DEYSE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2497 HERNDON AVE STE 104
CLOVIS CA
93611-8977
US

IV. Provider business mailing address

2497 HERNDON AVE STE 104
CLOVIS CA
93611-8977
US

V. Phone/Fax

Practice location:
  • Phone: 559-900-7133
  • Fax: 559-899-2619
Mailing address:
  • Phone: 559-900-7133
  • Fax: 559-899-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: